Acute acalculous cholecystitis
Updates to Article Attributes
Acute acalculous cholecystitis (AAC) refers development of cholecystitis either in a gallbladder without gallstones on in a gallbladder with gallstones where the stones are not the contributory factor to the development of cholecystitis 2.
Epidemiology
AAC usually occurs in critically ill or injured patients, and appears to be increasing in incidence.
Pathology
Ischaemia/reperfusion injury to the gallbladder is a central pathogenic feature.Other Other postulatedcontributory contributory factors include:
- bile stasis
- opioid therapy
- positive-pressure ventilation (PPV)
- total parenteral nutrition (TPN)
Radiographic features
When there are no gallstones, the diagnosis is easier.
Ultrasound
May show gallbladder wall oedema with pericholecystic fluid with gallbladder distention (the former two being considered two most important criteria 2). The sonographic Murphy's sign may be positive. A sonolucent intramural layer or “halo” that represents intramural oedema may also be present.
Scintigraphy
Tc-99m iminodiacetic acid cholescintigraphy is considered a highly reliable test and may be performed even in acutely ill patients. There is usually non-visualisation of the gallbladder.
-<p><strong>Acute acalculous cholecystitis (AAC)</strong> refers development of <a href="/articles/cholecystitis">cholecystitis</a> either in a gallbladder without gallstones on in a gallbladder with gallstones where the stones are not the contributory factor to the development of cholecystitis <sup>2</sup>.</p><h4>Epidemiology</h4><p>AAC usually occurs in critically ill or injured patients, and appears to be increasing in incidence.</p><h4>Pathology</h4><p>Ischaemia/reperfusion injury to the gallbladder is a central pathogenic feature. <span style="line-height:1.6em">Other postulated </span>contributory<span style="line-height:1.6em"> factors include:</span></p><ul>- +<p><strong>Acute acalculous cholecystitis (AAC)</strong> refers development of <a href="/articles/cholecystitis">cholecystitis</a> either in a gallbladder without gallstones on in a gallbladder with gallstones where the stones are not the contributory factor to the development of cholecystitis <sup>2</sup>.</p><h4>Epidemiology</h4><p>AAC usually occurs in critically ill or injured patients, and appears to be increasing in incidence.</p><h4>Pathology</h4><p>Ischaemia/reperfusion injury to the gallbladder is a central pathogenic feature. Other postulated contributory factors include:</p><ul>
-</ul><h4>Radiographic features</h4><p>When there are no gallstones, the diagnosis is easier.</p><h5>Ultrasound</h5><p>May show gallbladder wall oedema with pericholecystic fluid with gallbladder distention (the former two being considered two most important criteria <sup>2</sup>). The <a title="Sonographic Murphy's sign" href="/articles/sonographic-murphys-sign">sonographic Murphy's sign</a> may be positive. A sonolucent intramural layer or “halo” that represents intramural oedema may also be present.</p><h5>Scintigraphy</h5><p>Tc-<sup>99</sup>m iminodiacetic acid cholescintigraphy is considered a highly reliable test and may be performed even in acutely ill patients. There is usually non-visualisation of the gallbladder.</p>- +</ul><h4>Radiographic features</h4><p>When there are no gallstones, the diagnosis is easier.</p><h5>Ultrasound</h5><p>May show gallbladder wall oedema with pericholecystic fluid with gallbladder distention (the former two being considered two most important criteria <sup>2</sup>). The <a href="/articles/sonographic-murphys-sign">sonographic Murphy's sign</a> may be positive. A sonolucent intramural layer or “halo” that represents intramural oedema may also be present.</p><h5>Scintigraphy</h5><p>Tc-<sup>99</sup>m iminodiacetic acid cholescintigraphy is considered a highly reliable test and may be performed even in acutely ill patients. There is usually non-visualisation of the gallbladder.</p>
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